What is osteoporosis?
Osteoporosis is an abnormal weakening of the bones. that afflicts an estimated 44 million American adult women and men. Osteoporosis occurs when the bones become brittle and porous due to loss of bone tissue and deterioration of bone mass. This decreased bone mass can result in fragility of affected bones. This can lead to fractures of the hip, wrist, spine and wrist.
Bone is made of collagen (a type of protein) and a mineral called calcium phosphate that makes bones hard and strong. Normally, as new bone tissue is built, old bone tissue breaks down. one cycles through phases of removal (or resorption) and creation of new bone (formation). Bone formation exceeds resorption until around the age of 30. As we get older, bone breakdown occurs more rapidly than bone production, resulting in bone loss. resorption slowly begins to exceed bone formation.
Age and female gender are the primary risk factors for osteoporosis. is the #1 root cause of osteoporosis. Women who have entered into the menopause (no longer menstruating for a period of at least 1 year) are the predominant population likely to develop osteoporosis. The reason for this is that relatively sudden and significant drop in female hormones that signal bone formation drop significantly levels that take place upon entering the after menopause. which lead to a decline in bone density.
A diet deficient in calcium and vitamin D, insufficient weight-bearing exercise, and a genetic tendency all contribute to favor the development of osteoporosis.
Key Points:
- Osteoporosis is an abnormal weakening of bones due to loss of bone tissue – bones may become so brittle and weak that they fracture easily
- Females who have gone through menopause are at highest risk of developing osteoporosis.
What are the symptoms?
There are unfortunately few, if any, symptoms of Osteoporosis is a “silent condition” that does not cause symptoms until a bone breaks and causes pain. Telltale signs include loss of height and stooped posture due to break down of bone tissue in the spine. It is a silent, insidious condition and can result in a slow and steady decline in bone strength and density until the sudden onset of pain in the affected bone(s). Affected individuals may notice one or more of the following symptoms or signs:
Key Points:
Osteoporosis is a “silent” disorder that does not cause symptoms until severe. Signs and symptoms of bone loss may include:
- Pain in any bone, most commonly the spine, hip or wrist, or other bones, resulting from a fracture
- Stooped posture or hunched back and loss of height over a number of years
What are the risk factors?
There are many predisposing conditions that increase one’s risk for developing osteoporosis, including: Besides being a woman and postmenopausal, risk factors include:
- Personal history of fracture after age 50
- Current low bone mass
- History of fracture in a first-degree relative (sibling, parent)
- Female gender
- Being thin or having a small frame
- Older age
- Family history of osteoporosis
- Early (before age 48) or surgically-induced menopause
- Abnormal absence of menstrual cycles during adulthood
- Low calcium intake
- Vitamin D deficiency
- Use of certain medications, e.g. steroids, chemotherapy, anticonvulsants, antacids containing aluminum, heparin
- Certain chronic medical conditions, e.g. thyroid disease, parathyroid disease, kidney disease, Crohn’s disease
- Low testosterone levels in men
- Sedentary lifestyle
- Current Cigarette smoking
- Excessive use of alcohol
- Caucasian or Asian race (although any ethnic background may still be at risk)
Key Points:
Besides being female and postmenopausal, factors that increase the risk of osteoporosis include:
- Low intake of calcium or vitamin D
- Certain medications
- Cigarette smoking, too much alcohol or lack of exercise
- Being Asian or Caucasian
How is it diagnosed?
The key to identifying Osteoporosis can be diagnosed by a is to undergo a screening test known as “bone densitometry”, also known as or “bone mineral density” (BMD).
BMD testing is painless and non-invasive and safe and can help This test can detect early bone thinning early, before signs and symptoms occur., predicts the chance of developing osteoporosis, and if done at regularly scheduled intervals can determine the rate of change of bone density and the effects of any treatment.
BMD has been shown in numerous scientifically rigorous studies to directly relate to risk of fractures in both the spine and hip of at-risk individuals.
BMD testing is widely available in most, if not all, medical centers. Medicare, the leading health insurer of the older and more at-risk population, promotes and pays for BMD at 2-year intervals, and more frequently if there is medical indication.
Key Point:
- Osteoporosis can be detected early with a bone mineral density test
- Women over 50 or with risk factors should have this test done regularly
Can osteoporosis be prevented?
The best way to treat any medical condition is to prevent the onset of that condition. With osteoporosis, prevention is deemed the best approach and requires an early start. By about age 30, an adult’s bone density is at its peak and declines slowly and steadily after that, with a large drop after the menopause in women and continued decline in both sexes throughout the remaining years.
Building strong bones is vitally important. To accomplish this task, the following strategies have been shown to be useful:
Measures that can prevent or slow the process of bone loss include:
- Eat and drink foods rich in calcium and vitamin D (These will be discussed laterxx)
- Engage in weight-bearing exercise and resistance-training
- Adopt a healthy lifestyle with no smoking or excessive alcohol use
Key Point:
To help prevent or slow the development of osteoporosis:
- Eat foods that contain calcium and vitamin D
- Exercise regularly
- Moderate alcohol intake
How is it treated?
There are several good medicines at your doctor’s disposal for helping you regain some or all of your lost bone density and helping to stave off osteoporosis and reduce your risk for bone fractures at you age. Many of the medicines listed below are indicated for both prevention and treatment of osteoporosis:
The following medications can slow bone loss and help rebuild bone tissue:
- Alendronate (Fosamax“)
- Risedronate Actonel“)
- Ibandronate (Boniva“); in oral and injectable forms
- Raloxifene (Evista“)
- Calcitonin (a form of vitamin D), administered usually via nasal spray but also available in injectable form)
- Teriparatide (brand name: Forteo) is an injectable medicine given once daily for people unable to tolerate oral medicines or nasal spray with advanced osteoporosis
- Calcium and/or vitamin D supplements.
There are more medications. Discuss with your trusted health care provider which products are best for you.
Key Point:
- Once osteoporosis has developed, medications can help slow bone loss and restore lost bone tissue
What are some dietary sources of calcium and vitamin D?
To prevent or treat osteoporosis, you need an adequate amount of calcium and vitamin D each and every day. For non-pregnant adults between the ages of 18-50, 1000 mg of calcium and between 400-800 IU (international units) of vit D are recommended daily. More calcium is recommended (1200 mg) per day for women who are pregnant, breastfeeding or over age 50.
Calcium and vitamin D are available in a variety of foods. Many food products contain one or both of these essential nutrients. Calcium is easily found in dairy products and green, leafy vegetables. Vitamin D is found in nuts, oils, and seeds, among others.
Below is a list of the best sources of these essential nutrients:
Foods high in Calcium: Foods high in vitamin D
Milk Milk
Yogurt Fortified rice or soy drinks
Cheese Salmon
Tofu Tuna
Beans
Almonds
Salmon
Leafy green vegetables
Food Portion Calcium (mg)
Milk, whole, 2% or skim 1 cup 300
Yogurt, plain or low-fat 1 ounces 415
Yogurt, fruit-bottom 1 cup 250
Cheese 2 slices 265
Frozen Yogurt 1 cup 100
Tofu (calcium set) 3.5 oz 125
White beans _ cup 100
Almonds _ cup 95
Salmon, canned with bones 3 oz 180
Turnip greens cup 95
Bok choy _ cup 75
Broccoli _ cup 35
Orange 1 medium 55
OJ (calcium enriched) 1 cup 300
Foods high in Vitamin D
Food Portion Vitamin D (IU)
Milk 1 cup 100
Fortified rice/soy drink 1 cup 100
Fortified margarine 2 tsp 56
Salmon, canned, pink 3 oz 530
Tuna, canned, light 3 oz 200
Key Points:
- Eating foods high in calcium and vitamin D is important for people at risk of osteoporosis
- Many dietary sources are good sources of either or both
What are the complications?
Osteoporosis is responsible for approximately 1.5 million fractures annually in the U.S.
The estimated national direct care cost, including hospitals, nursing homes and outpatient services for osteoporotic fractures is over $20 billion per year and on the rise.
Complications related to of osteoporosis include: are mainly due to fractures and their consequences, including:
- Bone fractures, in one or more areas, usually lower spine, hip, thigh bone, wrist
- Impaired mobility due to any of the above fractures
- Chronic pain
- Stooped posture as a result of multiple micro-fractures of the spine
- Increased disability need for short- and long-term care in a nursing home or similar facility
One last complication is related to:
Medications for treatment of osteoporosis can cause some complications. Ask your doctor to explain these to you.
- Side effects of the medications for osteoporosis. Several are known, and a few are potentially serious. Please talk to your doctor regarding your risk/benefit profile in determining which medication(s) is right for you.
Osteoporosis can be a devastating disease with a slow onset but a rapid cause of decline. Prevention is never too late. Treatment is very effective. Screening is key to uncovering your current risk and modifying your lifestyle accordingly. Please consult your family doctor for further information.
Key Point:
- Fractures caused by osteoporosis can lead to chronic pain, immobility, and disability
Fast Facts:
- Osteoporosis is a weakening of the bones due to loss of bone tissue – bones may become so weak that they break easily
- Women who are post-menopausal are at highest risk of osteoporosis, due to declines in hormones that help with bone production
- Smoking, excess alcohol, and lack of exercise increase the risk
- Osteoporosis does not cause symptoms until bones break. This causes pain in the affected bones
- Stooped posture and loss of height are telltale signs of osteoporosis
- Osteoporosis is diagnosed with an xray exam called a bone mineral density test – postmenopausal women and people with other risk factors should have this test done regularly
- Eating foods that contain calcium and vitamin D can help prevent osteoporosis
- Quitting smoking, moderating alcohol, and routine weight-bearing exercise can also help
- Osteoporosis that has already developed can be treated with medications that slow bone loss and help rebuild bone tissue
Fosamax is a registered trademark of Merck & Co; Actonel is a registered trademark of Proctor & Gamble Pharmaceuticals; Boniva is a registered trademark of Roche Laboratories; Evista is a registered trademark of Eli Lilly & Company.
References:
1. Osteoporosis. Information from your Family Doctor. American Family Physician. 2004. 69(5).
2. Food Sources of Calcium and Vitamin D. BC Health Files. 2005 (68e).
3. Osteoporosis. US Food and Drug Administration. Office of Women’s Health.
4. www.nof.org/osteoporosis - accessed 02/06/2007
5. Bennett, B. Osteoporosis. The National Institute of Health “Word on Health”. 2003.
6. US Department of Health and Human Services. The Surgeon General’s Report on Bone Health and Osteoporosis. 2004.
7. http://www.niams.nih.gov/bone/hi/overview.htm
